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Review of literature Research idea Research problem Conclusions/ recommendations Research objectives Discussion of results Hypotheses Data analysis Frameworks/ definition of variables Data processing Study design Data-collection Instrumentation Study population/sampling INSTRUMENTATION Development and validation of data-collection tool • • • • • Questionnaires Interview schedules FGD guides Lab form sheets Checklists QUESTIONNAIRE DESIGNS Outline 1. Concepts and definitions 2. Steps in questionnaire construction 3. Other issues in questionnaire development and administration DEFINITION • A questionnaire is a data-collection tool used to gather information about an individual, group, things, phenomena or events. • It is an instrument that can measure attitudes, cognitions, behaviors or other attributes. • It is a written document which… 1) respondent fills in by himself (self-administered) or with assistance from the researcher (interviewer-assisted) 2) collected by field interviewers (interviewer-administered) 3) may be sent through standard mail or cybermail. Developing a questionnaire is not easy. It is a tedious and time-consuming process. • Use existing relevant questionnaires • Modify existing questionnaires to suit the research requirements. • Items from several questionnaires can be combined. It is far more difficult to produce a valid and reliable questionnaire than you might think • Maximize response rates • Increase validity and reliability of responses • Careful choice on questions to be included • Careful design (wording, formatting, sequencing) of individual questions • Lucid explanation of the purpose of the questionnaire • Compliance to ethical standards • Pilot testing and eventually finalizing the instrument There are two common mistakes made by inexperienced investigators: 1)asking too many questions, the result of which may never be analyzed; and 2)asking too few questions that may be inadequate in satisfying the research objectives. Before you decide in using a questionnaire… Be certain that a questionnaire is the best way to obtain your information What information do you require? Who are your respondents? What are their characteristics and abilities? What are your restraints in terms of time, money and manpower? Have you considered other methods such as professional records, key informant interviews, focus group discussions, laboratory tests and secondary documents? Questionnaires are more suitable… • when distance is a problem • when the respondents are busy people • when accurate information is required rather than opinions, and • when time is short. STEPS IN QUESTIONNAIRE CONSTRUCTION 1. An effective questionnaire depends on the clarity of the research problem. • Questionnaire data must be able to provide an answer to the research problem. • Make sure that you have a clear, solvable research problem. 2. The path to solve the research problem is through a clear statement of the research objectives – The specific research objectives must be able to indicate what information is needed to solve the research problem – Only information that are relevant to the research objectives should be obtained. – Keep the research objectives handy when you are working on the questionnaire. EXAMPLE 1. Research problem: Why do persons with leprosy delay their medical consultation? 2. General objective: To assess the reasons why persons with leprosy delay their medical consultation. Specific objectives: 1. To know the prevalence of people with leprosy in the sample community. 2. To know the ratio of patients seeking medical help vis-a-vis those who have not sought any medical attention 3. To determine their socio-demographic characteristics. 4. To assess their perceptions and attitudes about their health conditions 5. To identify the reasons why patients seek or do not seek medical help. 3. The research objectives will help us decide what data need to be collected Health-seeking Socio-demographics Prevalence Ratio with/with out leprosy questions Ratio healthseeker/no health seeker questions age, sex, ses, cs, educ questions Perceptions/attitudes Concept of disease questions Feelings about having the disease questions Factors in health seeking Socio-cultural, psychological. Economic, health service, clinical questions 4. The research objectives will also help us decide whether the questionnaire is the best tool to collect that data that we need What type of information is needed to be captured? (facts, attitudes, behavior, beliefs, attributes) How deep should the information be (description, dynamics, how, why) 5. What type of questionnaire do you need? 1. Descriptive 2. Measurement scales 3. Combination of descriptive and scales 6. What type of questions would you like to include? • Open-ended: What is your opinion about the present state of skin care in the Philippines? • Closed-ended: Are you in favor or not in favor of the current skin care system? [ ] Yes, I am in favor [ ] No, I am not in favor [ ] Could not say/don’t know • Partially closed-ended: Which of the following do you think is most responsible for the popularity of cosmetic dermatology in the country? [ [ [ [ [ ] endorsement from celebrities ] testimonies of those who have undergone cosmetic dermatology ] increasing concerns of people about good physical appearance ] influx of new technologies ] others _________ (please specify) Open vs. Closed Open-ended question • • • • Greater freedom for respondent to answer Could better capture the depth of response Processing and analysis of data is more complicated Entails more work from respondents Closed-ended question • Requires less effort and less facility with words • Easier to analyze • Less time-consuming • Difficult to develop good closed-ended questions 7. How would you style the questions? • List - The respondent is given a list of choices, any of which may be selected • Category- Only one response can be selected • Rank -Respondent is asked to place something in order • Rating scales -A rating device is used to record response • Quantity- Response is a number giving the amount List questionsThe respondent is given a list of choices, any of which may be selected Please choose the types of skin diseases that are common in this community. Scabies Leprosy Tinea Versicolor Eczema Acne Melasma Psoriasis E R Others (please specify______) Category question Each respondent’s answer can only fit one category How often do you visit your dermatologist? Once a month 2-3 times a month At least once every 6 months At least once a year Others ____ What’s wrong with these responses? Do not forget to use ‘Don’t Know’, ‘Other’, ‘Not Applicable’. That is, do not force people to answer questions that they might not be able to answer Ranking question Respondent is asked to place something in order • Should not ask respondent to rank more than 15 items • In telephone questionnaire, should not ask respondent to rank more than four responses Ranking question • Rank-order the three most important reason why you specialized in dermatology (where 1 indicates the most important reason): Interesting Profitable More job opportunities Most in demand Less academically demanding Others __ Rating scales questiona rating device is used to record the response 1. Likert type “Sun exposure is bad for my skin” /---------------/-----------------/----------------/----------------/ Strongly Agree Agree Neither Agree nor Disagree Disagree Strongly Disagree My experience of depression during the past week was: [ [ [ [ ] ] ] ] none a bit moderate a lot Rating scales question • Semantic differential (SD) or adjectival rating scale. In the SD, a pair of bipolar objectives are used to express the subject’s feelings about the concept. Our present skin care system………. Is efficient 1 2 3 4 5 Is not efficient Is accessible 1 2 3 4 5 Is not accessible Of quality 1 2 3 4 5 Not of quality Sensationalized 1 2 3 4 5 not sensationalized Guttman scale – where the respondents rate a variable on a sliding scale. “How confident are you with your facial appearance? Are you…. (Check one) Unable to go out of your house at all? Able to go out but with make up? Able to go out even without make up? Quantity question • When did you start seeing a dermatologist? ________ • How many times a month do you go to a skin care clinic? _____ • Keep words as simple as possible (Grade 6 level). • Keep the question clear and specific. • Avoid double-barreled questions. (e.g., Do you feel dizzy and feverish after undergoing liposuction?) • Avoid using double negative statements (e.g., The lack of laws to control exorbitant professional fees for skin care is not a problem in the Philippines) • Avoid too demanding questions (e.g., ranking a large number of items). • Avoid leading or biased questions • Make sure that questions are applicable to all respondents. • Avoid threatening or embarrassing questions. • Avoid using jargons and other foreign phrases • 9. You need to code the responses • Coding consists of assigning code numbers to the response categories 1. Pre-coding • In pre-coding, code numbers are assigned to each response category while the questionnaire is being constructed although this is limited to questions whose answer categories are known in advance. I believe in trying out different doctors to find out which one I think will give me the best care." (Circle One) (1) Strongly Agree (2) Agree (3) Disagree (4) Strongly Disagree 2. Post-coding refers to coding conducted after questionnaires have been completed by respondents. It is used for complex open-ended questions where pre-coding cannot easily be done. 1. List down all responses to an open-ended question 2. Make broad categories based on responses.Code each category 3. Put each response in a certain category with its corresponding code. 10. The questionnaire must have a good format 1. The questionnaire must look and read simply and clearly. POOR FORMAT: "What is your approximate monthly income?" ____ Under P 5,000 ____ P 5,000 - P 9,999 ____ P10,000 - P 19,999 ____ P20,000 or more BETTER FORMAT: "What is your approximate monthly income?” [ 1 ] Less than P 5,000 [ 2 ] P 5,000 - P 9,999 [ 3 ]P10,000 - P 19,999 [ 4 ]P20,000 or more 2. Questions should be grouped in ways which will seem sensible and understandable to respondents, and should not appear to jump randomly from one topic to another. Use a transition statement, i.e., an introductory phrase to explain why the next questions are asked so that respondents retain a sense of the logical flow of the questionnaire. “The past questions asked about some of your socio-demographic characteristics, now, the next questions will inquire about your opinions about the skin care system in the country…” 3. If some questions are not relevant to all respondents, filter questions can be used which direct respondents to skip certain questions. 1. Are you currently practicing as a skin specialist? Yes/No If your answer is “No”, proceed to question 3. 2. How long have you been practicing as a skin specialist?____ 3. What factors have hindered your practice? Filter questions should not require extensive page flipping by the respondents or memory of answers to earlier questions. 11. Sequencing of questions • Straightforward and easy to answer questions at the beginning of questionnaire. • Complex and difficult questions placed towards the middle of the questionnaire. • Personal and sensitive questions towards the end of the questionnaire Never start a questionnaire with an open question that requires a lot of writing. • Since some demographic questions may be perceived as threatening (for example, level of income), put these questions at the end of the questionnaire. • If a questionnaire deals with more than one topic, complete questions on a single topic before moving on to a new topic. • Arrange types of questions to increase variety and decrease response set (i.e., the tendency to respond in a certain pattern, without proper regard to the particular questions). • Keep the questionnaire as short as possible by removing questions that are redundant, or unlikely to be analyzed. • Consider the salience of the questions to respondents when deciding how long the questionnaire should be. Respondents will be more willing to complete a questionnaire if the topic is relevant and interesting. 12. Do a cover letter explaining the purpose and mechanics of the questionnaire, and ethical issues 1. Introduce self as interviewer or investigator 2. Tell what the research is all about, its purpose and why respondent’s response is important, 3. Say how information will be asked and how long it will take to complete 4. Assure confidentiality of responses or anonymity, how results will be used 5. State whom to contact if have any queries, who to return filled questionnaires to and date by which should be returned 6. Thank recipient for their help 7. Signature, name and title. Include an informed consent form The objectives and mechanics of the survey was explained to me and I understood it well. I I also understand that my participation is voluntary and I can withdraw from the survey after having agreed to participate. I am free to refuse to answer any question that is asked in the questionnaire. I hereby provide INFORMED CONSENT to take part in this study entitled…. Participant signature: Witness: Date: Sign: 13. Translate the questionnaire into some native dialect, if necessary 2 forward translator 1 backward translator Pilot testing Pre-testing or piloting of the questions is not optional — it is crucial. If time or money does not permit pilot-testing of the questionnaire, then the study should not be conducted at all. 14. Pilot test the questionnaire Pilot-testing can be used to sharpen the focus of questions, structure certain responses, eliminate irrelevant, vague questions, and can be of great help in revising the wording of questions. Other aspects can be piloted such as: • paper color • Font • timing of each section of the questionnaire (to avoid overburdening respondents) Pilot testing 1. Ask expert or group of experts to comment on the representativeness and suitability of the questions 2. It is a good idea to obtain peer evaluation of the draft questionnaire. Test the revised draft on yourself, friends, relatives or co-workers. 3. Administer the questionnaire to a group as similar as possible to the final population in your sample The following questions can be addressed through piloting: • Do the respondents understand what the questionnaire is about? • Do they feel comfortable answering the questions? • Is the wording of items clear? • Do the respondents draw the same meaning as you intended? • Are the answers adequate for the purposes of the study? Is there sufficient detail? In the case of open-ended questions, is there so much variety among answers that the data will be difficult to analyze? • Are there regional differences in the interpretation of questions? Are there local expressions that should be incorporated into the items to avoid ambiguity? • Which items or sections are most difficult for the respondent to answer? • Which seem to produce irritation,embarrassment or confusion? • Are there any items that the respondent considers irrelevant? • Is the questionnaire too long? • Do the filter questions and skips work properly? • Are the instructions clear? • Are the transitions from question to question and section to section smooth? Cognitive debriefing form Did you have difficulty understanding this question? What does this question mean to you? Is the question relevant to your condition? How would you have worded this question? Did you have difficulty understanding this response choice? What does this response option mean to you? How would you have worded this response option? Is it consistent with the question? Did you have difficulty understanding this instruction? What does this instruction mean to you? How would you have worded this instruction? Question 1 Question 2….. Response choice 1a 1b…… Instructions 15. Administer the questionnaire • Once the questionnaire has been piloted and modified where necessary, it can be printed in bulk and distributed to the sample population. • Before distribution, you must have decided on your sample population, the sample size, and how the questionnaire will be distributed. The questionnaire can be: 1. self-administered 2. interviewer-assisted 3. interviewer-administered 4. mailed or cybermailed 5. asked through telephone interviews